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Improved gas exchange and survival after KL‐4 surfactant in newborn pigs with severe acute lung injury
Author(s) -
Zimmermann Anna M.,
Roberts Kari D.,
Lampland Andrea L.,
Meyers Patricia A.,
Worwa Cathy T.,
Plumm Brenda,
Pacheco M. Cristina,
Wolfson Marla R.,
Mammel Mark C.
Publication year - 2010
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21252
Subject(s) - pulmonary surfactant , medicine , atelectasis , lung , anesthesia , surfactant therapy , arterial blood , acidosis , gastroenterology , chemistry , biochemistry , biology , pregnancy , genetics , gestational age
Abstract Objective To determine the effectiveness of artificial surfactant therapy using KL‐4 surfactant in newborn pigs with hydrochloric acid (HCl)‐induced acute lung injury (ALI). Design After induction of ALI via intratracheal HCl instillation, pigs were randomized to receive 5.8 ml/kg KL‐4 surfactant or no surfactant prior to extubation to bubble CPAP. Setting Clinical laboratory. Subjects Spontaneously breathing newborn pigs (<1 week of age). Interventions Treatment with KL‐4 surfactant on bubble CPAP with PEEP of 6 cmH 2 O for 3.5 hr after extubation compared with controls. Measurements Physiologic parameters and arterial blood gases were measured every 15 min. At the conclusion of the study, the lungs were excised for the analysis of histopathology and morphometric data. Main Results Pigs treated with KL‐4 surfactant had arterial blood gases with less acidosis ( P < 0.001), higher P a O 2 levels ( P < 0.001), and lower P a CO 2 levels ( P < 0.001). Pigs treated with KL‐4 surfactant had improved survival compared with controls (6/12 KL‐4, 2/12 control, P < 0.05). Postmortem morphometric data demonstrated that pigs treated with KL‐4 surfactant had larger ( P < 0.05) exchange units in the caudal‐dorsal lung as compared to relatively atelectatic region in the control animals. Conclusions In newborn pigs with severe HCl‐induced ALI, treatment with KL‐4 surfactant resulted in improved respiratory parameters, less dependent atelectasis, and improved short‐term survival. Pediatr. Pulmonol. 2010; 45:782–788. © 2010 Wiley‐Liss, Inc.